資料:Why Do Addicted Patients Attend Self-Help Groups for Extended Periods ?

(Graduate School of Core Ethics and Frontier Sciences, Ritsumeikan University)

0. Nature of the Problem
Some individuals with the problem of addiction 1) attempt to get over it by attending self-help groups (SHGs), including Adult Children Anonymous (ACA) and Alcoholics Anonymous (AA). Furthermore, relatively large numbers of SHG attendes participate for a long time. Indeed, evidence from the AA Convention 2) held in 2007 in Osaka, Japan and the Big Book, in which stories of addicted patients' experiences are compiled, shows that most people tend to retain a tie to AA over the long term (three or fi ve years, for example).
This paper approaches the question of why addicted patients tend to participate in SHGs for extended periods from the perspective of narrative theory. First, consideration is given to earlier studies prior to the narrative theory about SHGs. As indicated by Itoh [2000], many earlier studies discussing the effects of SHGs have broadly viewed the fundamental functions of SHGs as the communication of knowledge and emotional effects. In recent years, however, these studies have been subjected to a more critical evaluation, and many researchers have attempted to analyze the functions SHGs play from the perspective of stories and narrative.
Even in studies discussing the effects of SHGs in terms of narrative theory, the arguments that tend to be made focus on the communication of knowledge between individual members and the signifi cance of this phenomenon. (Itoh [2000:96-97])
What the old narrative theory lacks is a unique viewpoint of narrative which enables people to accept their changes as a page in their lives through the process of telling their own stories, retelling them, and living in their own stories. This paper advances arguments in line with the arguments made by Tomohiko Asano [2001], including criticism of what is lacking in narrative therapy, while using the constructional methods of narrative therapy analysis as a basic framework. (Noguchi et al.)
The perspective of narrative tends to conceal the paradox of relations with the self itself (self-reflection), as indicated by Asano. Most studies that adopt an approach from the perspective of narrative theory have not clearly described the need for other people in order to resolve the paradox of internal dialogue, as pointed out by Asano, while viewing the self as a narrative. This paper emphasizes that SHGs function as a tool to resolve the paradox, the logical outcome of which is a prolonged period of visits to SHGs. This study examines the potential for a prolonged period of visits to SHGs based on narrative theory, rather than the extended period itself. The fi eld notes used in this paper were made through participating in various meetings, including those held by ACA, NA, OA and AA as well as the addiction forum 2007 3) held in Kyoto last year, in which I took part, as an executive committee member, together with patients with drug or alcohol dependency.

1. Self-Help Groups for Addictions
1. 1 History of Alcoholics Anonymous

Although there are various types of self-help groups (SHGs), including those for addicted patients, the origin of these groups is Alcoholics Anonymous (AA), which protects participants' anonymity (as its name implies) and levies no dues or fees for AA membership. AA members call each other by their nicknames, based on the principle of equality. The only requirement for its membership is to be an alcoholic and to have the desire to stop drinking. As a SHG, AA uses a program called the “12 Suggested Steps” in its meetings. AA is the origin a 12-step program SHG. With a long history in the U.S. – the birthplace of the organization – and other countries, AA has the largest membership and the largest number of district groups. The expansion of its membership has contributed to the establishment of various SHGs dealing with addictions in areas than alcohoism and has had signifi cant infl uences on the principles and policies of the SHGs that were established after AA.
SHGs for addicts include Narcotics Anonymous, Overeaters Anonymous, Gamblers Anonymous, and Cocaine Anonymous, all of which 4) were launched based on the AA model. They adopted the AA system, or the 12-step program unique to AA.
AA dates back to 1935, when Bill Wilson and Bob Smith, both of whom were chronic alcoholics, began a recovery program in Akron, Ohio. The two founders, a stock broker (Wilson) from New York and a surgeon (Smith) from Ohio, met each other in 1933. In those days, they tried to fi ght their own battles against drinking and failed repeatedly for years.

1. 2 Classifi cation into Two Groups: the 12-Step SHG and the Non-12-Step

SHGs can be broadly classified into two groups: those that have adopted the 12- step program of AA and those that have not. As indicated aptly by Katz, it is necessary to clarify the differences between the two groups. Katz admits that in grouping SHGs, consideration should be given to many factors, including issues dealing with classification, race, gender and age of membership, and the presence or absence of social policies. However, he argues that the adoption of the 12-step program is the most basic and important classifi cation criterion. (Katz [1993=1997:11-27])
In adherence to the principles of the Oxford Group, the 12 steps that AA developed incorporate many spiritual concepts. The SHGs that have adopted this 12-step program emphasize that people should admit their powerlessness and accept a higher power, marking a clear separation from non-12-step SHGs 5).

1.3 Classification of Two Types: Treatment-Conscious SHGs and Social

Change-Conscious SHGs
Tomofumi Oka [1988] argues that the functions SHGs serve can be divided into two: the self-transformation function, which focuses on changes in ways of thinking and behaving, and the social change function, which centers on the social environment surrounding group members. (Oka [1988:12-16]) In AA, the members receive advice from senior members to help them overcome their alcoholism and achieve sobriety soon after entry into AA, and gradually they come to assume the role, themselves, of conducting educational campaigns to raise public awareness of AA among addicted patients. It is hard to draw a clear distinction between the social change-conscious group and the treatment-conscious group. However, this can be regarded as one of the classifi cation criteria due to the fact that a particular group will place more emphasis either on self transformation or social change 6) .

2. Approaches to the Effects of Existing SHG
2. 1 Effects of self-help groups

This paper mainly deals with large, anonymity-based, treatment-conscious SHGs for mentally ill people 7) . Most studies conducted thus far have focused on the effects of SHGs on their members. For example, T. Borkman indicated that individual members of SHGs have experiential knowledge, unlike experts with systematized knowledge.
T. Borkman argues that experiential knowledge represents a high degree of confi dence that the insight gained by direct involvement in a certain specifi c situation is true and that such knowledge, unlike specialized knowledge, is more practical and puts more emphasis on behaviors at the present moment rather than long-term progress. Therefore, he regards experiential knowledge as general knowledge involving emotional factors, rather than limited knowledge from physiological and pathological perspectives.
P. Antze indicates that SHGs have an ideology. He calls the integrated entirety of wisdom an ideology, referring to the teaching system established by individual groups. He also argues that an ideology plays a role as an antidote to change the basic perception and attitudes of SHG members. Given this perspective, he warns that professionals involved in SHGs should be careful not to undermine the ideologies of individual groups. In the case of AA, its 12 Steps and Higher Power are deemed to be an ideology. In sum, P. Antze emphasizes that the ideology absorbed gradually by participants can bring about changes in their perception and attitudes. (Itoh [2000: 93])
In addition, F. Riesmann points out the existence of the helper therapy principle in SHGs. (Riesman [1965:27-32])When confronting a problem, we tend to depend on some body else who has more knowledge and experience. However, this solution defi nes the relations of the two as the “advice seeker” and “advice giver,” even before advice is actually received. Moreover, this relation creates the feeling in the advice seeker that he or she is under an obligation to the advice giver, if not a hierarchical relationship. In other words, those who receive advice may be put in an inferior position in relationships with those giving advice and may lose their pride. In contrast, the advice giver tends to have a sense of superiority or improve his/her own selfesteem.
Some researchers think of AA as a sort of apprentice system. Lave et al. described this as follows:
AA provides a description of changes in the form of members' involvement in the group from a newcomer to a senior member. AA guides its members along the process from peripheral participation to full-fledged participation, significantly helping its members, just like a catalog of clothes for a tailor's apprentice, where the catalog serves as a progress chart through the apprenticeship system. (Lave and Wenger [1991=1993:61])
Analysis by Lave et al. shows that AA members learn through such an “apprenticeship” that AA's perspective is important in recovery and fi nding a solution to their own problems.
A broad overview has been given to the arguments of four researchers on the effects of self-help groups. However, some researchers are critical of these effects. In the next section, such critical arguments will be examined.

2. 2 Criticism of the Effects of SHGs and the Meaning of Recovery

Itoh indicates that experiential knowledge, the helper therapy principle and ideologies share a certain common model. In the model, messages that contain something to teach, including knowledge and wisdom, have been accumulated within a group, and participants absorb them through linguistic interactions. It means that the quality of such messages determines the changes that take place in the participants. This explanation is plausible ok since SHGs have distinctive discourses. It is diffi cult to confi rm what is an “ideology” and what is “experiential knowledge” and how they can be accumulated and conveyed. Of course, there are some discourses that clearly contain instructions, and some participants use abstract terms unique to the SHG they belong to. However, they are relatively limited, and much of the time is spent relating or listening to individual episodes, and this is far removed from teaching. It is unreasonable to argue that each of these episodes can be accumulated within the group as experiential knowledge. (Itoh [2000:51])
It is true that in the helper therapy principle, support providers guide support receivers using their experiential knowledge. For example, established members teach newcomers what the meeting rules are and how to chair a meeting. However, this only indicates that assistance is given to participants who have recovered to a certain extent from addiction through experiential knowledge. In short, there is no explanation about how participants change their status from those receiving help to those providing help.
The helper therapy principle is often cited as one of the functions the SHGs perform, because it is very persuasive when we consider the experience that we only come to understand our own stories better only when we tell them to others. However, while this principle intends to break down the stereotypical image of those offering a service and those receiving a service, it only provides a limited view concerning the functions of SHGs. The view is that participants who have already become actively involved in group activities often extend assistance to newcomers and potential participants, which is effective in enhancing their motivation and positive attitude. (Itoh [2000:92-93])
Lave et al. have also not identified what and how participants are learning and have presented no clear learning process. They argue that during an apprenticeship, apprentices start to learn the peripheral knowledge of senior members and gradually internalize the program. However, they have not discussed why SHGs can have the same effect. Thus, conventional arguments have not adequately explained what effects SHGs have.

2. 3 Meaning of “Recovery” for Addicts

What conditions have to be met before addicts can be considered as recovered? This question is diffi cult to discuss without involving the addicts themselves. In particular, arguments of the effects of SHGs on problems with addiction should be made based on a certain degree of improvement regarding such problems. What level of improvement, then, do SHG members regard as recovery?
AA members claim that an addiction cannot be cured just by continuing to abstain from alcohol. Even if an alcoholic is able to kick the habit, it is not a true resolution to their addiction as long as they suffer from what they call “dry drunk” syndrome. If an individual experiences wide mood swings when he or she is abstaining from alcohol, the individual is essentially in the same condition as when intoxicated, or in a state that exhibits the behaviors and thinking of an alcoholic without actually having taken a drink. (Kasai [2007:114])
An alcoholic confessed: I determined to get over my alcohol addiction many times, but I failed. I always think that this is the last drink and I will go on living as if I were dead. On the following day, however, I change my mind. I experience such wide mood swings that I no longer know who I really am ‒ the person who gets up in the morning, when working at the offi ce, when drinking at the pub, or when feeling the effects of alcohol? (AA [2002:305])
As shown in such a confession, many alcoholics suffer the dry drunk syndrome. Even if you are determined to break your back from tomorrow, you cannot get motivated and instead feel like drinking on the following day. AA members do not consider such a state “recovery.” From the viewpoint of patients, such frequent mood changes cannot be regarded as a cure. The reality of recovery in AA consists of mutual relations between such individual members. As alcoholics have physical symptoms, it is easier to understand. In the case of adult children, however, it is more difficult to ascertain what state or stage can be regarded as recovery because some may suffer from addiction and it also involves state of mind such as “hard to live” and “feel anxious about interpersonal relationships.” Importantly, what is common to alcoholics and adult children is that whatever form of objective evaluation is used, they cannot be considered recovered unless they accept their own situation and outgrow the feeling that it is hard to live.
This is an important perspective when thinking of people as a story. patients can be regarded as recovered only if they can tell a narrative, from the perspective of themselves rather than from the viewpoint of others,that is convinces to themselves. If this is correct, such narratives are generated through communication between SHG members. Few studies conducted so far have focused on the role that communication plays in the process of recovery. To overcome this problem, some researchers have conducted studies dealing with the effects of SHGs from the perspective of narrative theory.

3. Self-Help Groups and Narrative Theory
3.1 Existing Narrative Theory the on (SHGs)

Studies conducted on SHGs from the perspective of narrative theory have certain characteristics: the distinctiveness of the structures of stories told in SHGs, the distinctiveness of the place where stories are told, and identifi cation of the effects of such stories. C. Cain, who considers the process by which a self narrative comes to be told as the process of acquiring identity, indicates that in AA, newcomers learn the principle of the group and modify their narratives through communication with senior members. (Cain [1991:210-253])
D.R. Mains pointed out that in SHGs for diabetics a norm exists that defines the direction of narratives on meta-criteria, which is described in relation to the concept of meta-narrative. He argues that whether the story told fi ts the meta-narrative or not is the decisive factor in determining whether the teller can be accepted into the group. (Mains [1991:185-202])
Itoh [2000] indicates that these studies conducted from the perspective of narrative theory have similar problems to those found in studies by P. Antze and T. Borkman. For example, Itoh criticized the meta-narrative model presented by D.R. Mains, saying that it is true that SHGs, which have their own objectives and policies, set the limits of the acceptable scope of narratives, but it is doubtful that members who play a central role in their SHGs share a common meta-narrative. Itoh critically argues that after all, Mains only presented a broad generality that stories shared commonly by SHG members are the stories that cause emotional responses in the members of a SHG and are generated and consumed frequently. Concerning C. Cains' arguments, Itoh notes that a model given to newcomers by senior members in the process of acquiring identity exists in the coded form of the group principle, which individual members learn via the vehicle of a story. (Itoh [2000:98-99])
As in conventional studies, a critical eye has been cast on these approaches in relation to the effects SHGs have on their members' recovery from the perspective of narrative theory. Given these observations, there is a stream of research that is examining whether or not narratives in SHGs play the same role as psychotherapy.

3. 2 Narrative Approach and “Free Saying, Free Listening”

Unlike the paradigmatic approaches on which natural science has relied thus far, the narrative approach starts with the proposition that people should be viewed as independent beings open to various opportunities, rather than as passive objects only capable of observation. According to White & Epston [1990], the paradigmatic mode depicts individualism as a passive arena, or an area in which responses are made to impersonal power, drives, impacts and energy motion. These researchers argue that it is natural that a certain power, whether it is inside or outside of people, acts on people and determines and constitutes their life. In contrast, the narrative mode views people as a leading character or a participant in their worlds. It is the world of interpretative act, in which a re-told story becomes a new story and people get involved in re-authoring, thereby creating their lives and relationships. (White & Epston [1990=1992:106]) White & Epston argue that the view wherein an observer is seen to exist in an existing objective world should be abandoned and that greater emphasis should be placed on the formation of narratives.
K.J. Gergen indicates that therapy conducted from the standpoint of social constructionism focuses on “polyphony.” Polyphony means diversified voices in a diffi cult situation. The purpose of polyphony in this context is to create a variety of new options, not to fi nd a solution or a new story. When there are many voices around a client, various doors are opened to him/her. (Gergen [1994 = 2004:258])
Noguchi [2002] mentions the rule of “free saying, free listening” as a tool to bring out polyphony, as indicated by Gergen, in SHGs. He also argues that similar effects to the narrative approach have been observed in the anonymity-based SHGs, including AA and ACA, which have adopted the rule of “free saying, free listening,” though the term “narrative approach” has not been used. (Noguchi [2002:164-168])
AA members also expect other members to accept the rule of “free saying, free listening.” In an ACA meeting in which I participated, for example, one of participants ignored the rule of “free saying, free listening” and directed his comments at another participant. The person who was the object of these comments got angry and said that while one participant is speaking, the rest have to listen to him under the rule of “free saying, free listening.” (Filed note: December 2007) In other words, the rule of “free saying, free listening” has been so fully internalized by participants that any rule violation arouses anger.

4. Self-Help Groups as a Place to Bring Out Narratives
4. 1 The 12-Step Program as an Auxiliary to the Quest Narrative

A. Frank [2002] divides the illness narrative into three groups restitution narrative, chaos narrative, and quest narrative. The restitution narrative is a modern story plot, as depicted in K. Plummer's “Telling Sexual Stories.” K. Plummer argues that the 12 Steps is a restitution narrative, citing a specifi c case. This perspective can be accepted in that the 12 Steps become available as the fi nal message sent out by an anonymitybased self-help group (SHG). In reality, however, participants in SHGs are not always on a single track to the restitution narrative. Instead, it seems to be closer to the quest narrative. Frank argues that a quest story allows people to face pain and suffering.
The quest narrative accepts and takes advantage of illness as an opportunity to make a journey leading to a quest. (Frank [1995=2002:163]) Moreover, Frank says that Nietzsche is the father of the modern quest narrative. The philosopher, who was living with a chronic illness of unknown cause, calls his pain a “dog,” leading to the creation of a new relationship with his pain. (Frank [1995=2002:165])
The quest narrative tells about the pursuit of a new role; that of being ill. An ill person gradually comes to accept illness as a journey by creating a sense of destination. The meaning of the term “journey” emerges cyclically, as a journey is made to fi nd what journey people have been making. (Frank [1995=2002:165])
Frank argues that people can view illness from various perspectives, not just from a single viewpoint, by giving a name to their illnesses. He also indicates that people cyclically embark on a journey that gives them the opportunity to retell a story about the journeys they made in the past. This similar to the concept of the 12-step program of SHGs. In the 12-step program, furthermore,aloows for concurrent development. For example, an ACA participant said to his peers:

There is a two-step dance. Some people try Step 12 after Step 1, despite the fact that their problems have not been remedied yet. This is not a good idea; we need to take steps one at a time even while conducting a message campaign. (Field notes: October 2007)
This participant says that it is important to ascend the steps of the 12-Step program one by one, but at the same time, concurrent development is also necessary. This means that not only does the restitution narrative come out but there is also a search for restitution. In short, people follow the 12 steps one by one and sometimes they do it in reverse order, and in such a situation, the 12 steps function as a resource to gather the threads of a self narrative. As in the case of Nietzsche who called his illness a “dog,” addicted patients attend SHGs to talk about what name is most appropriate for their illnesses. Quest narratives are repeatedly practiced by going through the stages of the 12 steps many times. In other words, they rename their illnesses by repeatedly going back and forth among the 12 steps. SHG meetings are based on such a 12-step program and the rule of “free saying, free listening. The objective of SHGs is to yield a “unique outcome” under these conditions.

4. 2 Constructionism and Narrative Therapy

Noguchi [2005] argues that social constructionism does not directly lead to narrative therapy but is a just source of constructionism, and that in contrast to Berger's argument that a power relationship plays an important role in changing people, narrative therapy aims to nullify such a hierarchical relationship and pursue dialogues on an equal footing. Berger's arguments show a system in which high-ranking members guide and influence low-ranking members, whether it is in religion or therapy. An important premise of narrative therapy is to nullify such a hierarchical relationship. Based On this understanding, narrative theory argues that a self consists of stories. This means that the diffi culties in life also consist of stories, indicating the possibility of alleviating pain and addiction by changing a story.

White & Epston [1990] indicated the absolute arbitrariness of self that all “lived experience” cannot be conveyed by “narrated stories” by drawing a comparison between “lived experience” and the stories narrated about it. In other words, the past cannot be completely covered by stories and there is defi nitely a gap. Based on this premise, they divided self narratives into two, the dominant story and alternative story: and pointed out that a large gap between the alternative story and dominant story makes a storyteller feel as though it is difficult to live. A major therapeutic characteristic of narrative therapy is to free clients from their dominant stories and draw out an alternative story that incorporates the “lived experience” they have never told. Individual subjects are guided toward the idea that people are rich in lived experience, fragments of which are constructed as a story, and that a lot of lived experiences are consequently left outside the dominant story concerning their lives and their interpersonal relationships.
Some aspects of the lived experience left behind outside the dominant story provide rich and fertile elements for the creation and recreation of an alternative story. (White & Epston [1990=1992:35]) What is important here is that White & Epston defi ned the outside of the dominant story as a unique outcome, as Goffman did. A unique outcome, which covers various areas ranging from episodes, emotions, intentions, thinking and behaviors, is never incorporated into the dominant story although it exists in the past, present and future.

5. Self-Help Groups as a Tool for De-Paradox
However, Asano indicates that narrative therapy differs from constructionism. Asano posed a question: When self is generated through stories, who is relating the stories? His answer is as follows:
There is no alternative but to say it is the “self.” The self has already understood who it is, when considering that the narrative is about the self itself. Otherwise, the idea that a narrative is a story about the teller himself/herself must be denied. Therefore, it can be stated in this way: “the self is constructed by telling about the self itself.” As a result, a pattern is presented: “self narration” → “narrative” → “self construction,” meaning that “self narration” must have been there prior to “narrative” and “self construction.” (Asano [2001:195])
As indicated by Asano, constructionism is premised on self narration, which is followed by self construction. This is evident in the self construction of alcoholics. G. Bateson pointed out the following contradictions in the characteristics of alcoholics.
Seeking pride in risk and making it the principle of life means to seek selfdestruction. It is good to make a bet to learn whether the universe favors you. However, repeating the bet ‒ with its conditions reinforced on each occasion ‒ is nothing less than embarking on a project to prove you are hated by the universe. (omission) What alcoholics do not want to or cannot accept is that whether they are “drunk” and “sober”, the entire self of the alcoholic is an “alcoholic personality” and that it is a contradiction per se for a self with such a personality to fight against alcohol addiction. (Bateson [1972=2000:436-425]
The personality of being alcoholic contains self-referential aspects, as G. Bateson has already indicated in explaining that problems with self are constructed by self. In narrative therapy, however, a narrative to describe the experience of self means that a narrative is constructed in the past with the self telling a story as a starting point. It is always the other person listening to a self narrative who resolves the self paradox of “self narration” and “narrated self” (a dominant story and an alternative story). The self is constructed through a narrative, which constructivists call a “fiction.” However, a witness to a link between the “present” and the “past” of self is necessary in constructing a fi ction.
This view can be applied to AA, ACA and other SHGs. If a certain member relates his/her experience using what P. Antze calls ideology format at a SHG meeting, the ideology will foster the establishment of a better story in which the present “self narration” corrects the problematic alcoholic self. However, this is not a sort of explanation about what point is most appropriate for recovery, because it always goes further into the past from the present point, as indicated by Asano. Even if there is an ideology, it is diffi cult to continue to tell a restitution story because no ideology is able to capture a story narrated about the “lived experience” of self. Concerning this problem, Fukushige [2004] also brought up an interesting point:
If a narrative is considered an action to sort out the experiences a self has, it is impossible not to leave some residual experience in building a story. If a certain experience is told at a meeting, for example, there is no assurance that weakness is displayed: “I have said that, but something is different. My experience might be something different.” (omission) No narratives given at SHGs provide permanent, perfect “restitution.” Instead, such narratives help a self recover from suffering each time. That is why many SHG members try to attend meetings and talk about their experiences over a long period of time in order to seek “recovery” each time. (Fukushige [2004:312])
Participants in SHG meetings indicate that there is no permanent recovery, that only temporary recovery can be given because of changes in ideologies at each meeting, and that pain and suffering can be minimized by reconstituting a story frequently. I think this argument can apply to almost all people I have met.
At the same time, however, it can be indicated that as witnesses, SHG participants function together. It is true that the form of stories provided by SHGs does not offer a permanent “recovery.” There are some members who internalize “self narration,” with each story told at each meeting as the starting point. Some participants in ACA meetings, at which I was present as part of my fi eldwork, constructed a self narrative in a way to move close to the narratives made by other participants. Specifically, a participant told a story to the effect that she had become codependent because of her being a woman, and she allowed the next self-storyteller to share the conclusion of her story, in line with which other members gave their self narratives. (Field notes: December 2007)
In SHG meetings, participants signifi cantly on infl uence one another in providing story models. However, Fukushige [2004] only refers to the relationship with the self, but his argument does not cover the issue that the paradox of relationship with the self can be resolved in SHGs. Without resolving the paradox (de-paradox), participants just strengthen the self image they believe in regardless of what stories they tell, making it diffi cult to accept a self narrative that is accepted by both the storyteller and listeners. With regard to this issue, V. Burr [1997] argued as follows:
We largely depend on other people's positive willingness in constructing our own stories. We construct our own identities, or identify what we are, through our narrative explanations. In that context, our stories coincide with those of other participants who play an important role in our explanations. (Burr [1995=1997:209]) Our self narratives depend on other people's positive willingness to express the image of other people whose acts are suitable for our own stories, when we try to give our self narratives in our own way. This is also evidenced by the participants I met in my fi eldwork who have internalized the rule that you have to maintain the attitude of listening to whatever narrative is presented. In short, there is a characteristic that it is easier to describe the rule of “free saying, free listening” than to describe a self narrative.

6. Conclusion
Noteworthy in anonymity-based SHG meetings is that the 12-step program provides a loose framework for narratives, the process of which is repeated to give a name to suffering. In such a meeting, addicted patients give their self narratives, utilizing “unanticipated outcomes,” as an opportunity to recapture their suffering. However, there is the paradox of “narrated self” and “self narration” due to self narratives being provided in such an environment, and it is participants who contribute to resolving the paradox of a self narrative. Most studies concerning narrative theory conducted thus far have dealt with the effects of the existing SHGs on the recovery of their members with a focus on its communicative elements, and have paid little attention to the paradox that exists within the self. I believe that this paper has attempted to made a critical evaluation of these earlier studies and to describe a model for explaining the reason why addicted patients tend to attend SHGs for a long period. However, there is an issue that could not be examined by this paper: Is this prolonged involvement by patients in addiction focused SHGs observed in other SHGs that were not created for addictions.I would like to address this theme in future reserch.

1) In terms of the psychiatric defi nition, addiction is technically classifi ed into “dependence,” “abuse” and “toxication.” The term “dependence” refers to a state of mind in which it is diffi cult to escape from dependence despite the desire to stop using the addictive substance. “Abuse” means that there is no will to kick a habit despite excessive drinking or drug use, involving difficulties in legal, social and interpersonal relationships. “Toxication” refers to a physical problem rather than problems associated with a lack of will or sociality. The term “addiction” used in this paper is defi ned as a state of prolonged “dependence.” In this regard, however, it is not based on a doctors' judgment, and it is also used for an elusive state of mind in which people fi nd it hard to live, because in AC, there are some cases not involving addictions.
2) Held in the Kansai area, Japan on June 10, 2007. The event took place on this particular date since AA was founded by Bill Wilson on June 10, 1935.
3) The Kyoto Addiction Forum was held on June 16 (Sat) and 17 (Sun), 2007 at the Hito Match Koryukan in Kyoto. With the participation of over 100 members of the public and addicted patients, this event was held as an attempt to promote a dialogue that would overcome differences in status.
Narcotics Anonymous Founded in 1953
Overeaters Anonymous Founded in 1965
Gamblers Anonymous Founded in 1970
Cocaine Anonymous Founded in 1979
(Based on Katz [1993=1997])
5) In the US, non-12-step groups came to the fore in the late 1940s. Support organizations for mental retardation, cerebral palsy, hemophilia and muscular dystrophy reached maturity as self-help groups by the early 1950s. The groups voluntarily organized on a district-by-district basis by parents of children suffering from such diseases amalgamated by the 1950s to become state-wide or nationwide organizations.(Katz = Kubo [1993=1997:18])
6) “Treatment-conscious” may be an internalized term that should be used carefully. This term may suggest directions for giving the impression that all responsibility lies with individual patients, not society. However, this term is used here to show the direction in the specifi c case of addiction. As stated by P. Conrad and J. Schneider in their book entitled Deviance and Medicalization, AA has historically identified a pathological mechanism of alcohol addiction in terms of psychiatric medicine.
7) According to Kasai [2007], AA, which exists worldwide, has a membership of more than two million alcoholics.

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